合并顽固性高血压的尿毒症患者肾移植前切除双肾对移植肾功能的影响

Effect of pretransplant dinephrectomy on renal allograft function in uremia patients associated with uncontrolled hypertension

目的 探讨尿毒症合并药物难以控制的高血压患者肾移植前切除双肾对术后血压及移植肾功能的影响。方法 42例合并顽固性高血压的尿毒症患者分成 2组 (每组 2 1例 ) ,一组先行双肾切除 ,6个月～ 1年后再行肾移植 ,另一组不切肾 ,直接施行肾移植。对比分析 2个组肾移植术后的血压及移植肾功能的恢复情况。结果 切肾组在双肾切除后 ,13例 (6 1.9% )的平均舒张压低于 90mmHg或较术前降低 10mmHg以上 ;6例 (2 8.6 % )的平均舒张压较术前降低 15 %以上 ;肾移植术后1年 ,双肾切除组血压正常者 11例 (5 2 .4% ) ,对照组血压正常者 5例 (2 3.8% ) ,两组比较 ,差异有显著性 (P <0 .0 5 ) ;移植肾 1年存活率 ,切肾组为 95 .2 % ,对照组为 81.0 % ,差异有显著性 (P <0 .0 1)。结论 存在顽固性高血压的尿毒症患者若需行肾移植 ,在明确手术指征的情况下可先行自体双肾切除术 。

Objectives To investigate the effect of pretransplant dinephrectomy on blood pressure and renal allograft function in uremia patients associated with uncontrolled hypertension. Methods From May 1987 to 1997, 21 uremia patients associated with uncontrolled hypertension were subjected to the dinephrectomy before renal transplantation (group A). Another 21 cases of uremia associated with uncontrolled hypertension did not undergo nephrectomy before renal transplantation (group B). The blood pressure and renal allograft function recovery after renal transplantation in the both two groups were comparatively studied. Results In group A, the mean diastolic blood pressure after renal transplantation was lower than 90?mm Hg or decreased by over 10?mm Hg as compared with that before operation in 13 out of the 21 cases; the mean diastolic blood pressure was decreased by over 15% as compared with that before operation in 6 cases. One year after renal transplantation, 11 cases in group A and 5 in group had normal blood pressure ( P < 0.05 ). The one year survival rate of the renal allografts in group A and group B was 95.2% and 81.0% respectively ( P < 0.01 ). Conclusions Dinephrectomy can effectively prevent hypertension and maintain stable renal function after renal graft for uremia patients associated with uncontrolled hypertension.